{
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"FirstLineMailingAddress": "5840 CORPORATE WAY STE 101",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST PALM BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33407-2040",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-432-0111",
"MailingAddressFaxNumber": "561-432-1075",
"FirstLinePracticeLocationAddress": "7431 ATLANTIC AVE STE 52",
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"PracticeLocationAddressCityName": "DELRAY BEACH",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-432-0111",
"PracticeLocationAddressFaxNumber": "561-432-1075",
"EnumerationDate": "05/22/2018",
"LastUpdateDate": "09/02/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRAVES",
"AuthorizedOfficialFirstName": "MICHAEL",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "561-432-0111",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}